Provider Demographics
NPI:1740313287
Name:SMITH, CHARLES V (LMHC, LMFT, CAP, NCC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:V
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHC, LMFT, CAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3413
Mailing Address - Country:US
Mailing Address - Phone:727-641-8939
Mailing Address - Fax:727-585-9647
Practice Address - Street 1:417 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3413
Practice Address - Country:US
Practice Address - Phone:727-641-8939
Practice Address - Fax:727-585-9647
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMAC507269 SAP13083101YA0400X
FLMH8574101YM0800X
FLMT2433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000539300Medicaid